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Surgery for thalamic lesions is generally challenging because they are deep-seated lesions surrounded by vital neurovascular structures. Whether neuronavigation-guided transcortical-transventricular endoport-assisted endoscopic resection for thalamic lesions is feasible remains to be further evaluated.A retrospective review of 8 who patients received neuronavigation-guided transcortical-transventricular endoport-assisted endoscopic resection for thalamic lesions was performed. Preoperative and tumor-related variables and postoperative outcomes were analyzed.All lesions were located in the medial part of the thalamus, and most of them expanded forward, downward, or backward. Median size of lesions was 31 mm (range, 16-52 mm). Final pathology results confirmed that 1 case was a cavernous malformation, 3 were pilocytic astrocytomas, and 4 were glioblastomas. None of the patients had postoperative seizures. Gross total resection and long-term postoperative survival were achieved in all patients with benign lesions, while near-total resection (90%) was achieved in 3 of 4 patients (75%) with glioblastoma, and subtotal resection (90%) was achieved in 1 patient (25%). Among patients with glioblastoma, 1 patient remained free of recurrence at 16 months of follow-up; the other 3 patients had worse Karnofsky performance scale scores after surgery and died within 6 months.Combining the advantages of neuronavigation, endoscopy, and endoport techniques via the middle frontal gyrus approach can safely and effectively remove benign lesions in the medial part of the thalamus. This procedure can also be performed in well-selected cases of glioblastoma and likely confers a survival advantage for this rapidly and universally fatal disease.

The management of petroclival region meningioma remains the ultimate achievement in neurosurgery, because of the formidable technical challenges involved.To describe the technique and feasibility of the purely endoscopic far-lateral supracerebellar infratentorial approach (EF-SCITA) for the treatment of petroclival region meningiomas.We reviewed the clinical data of 10 consecutive cases of petroclival region meningiomas treated with the EF-SCITA from August 2018 to August 2020. The clinical outcomes were analyzed. The patient was placed in the lateral position, and then, a "C" shaped incision and craniotomy with exposed sigmoid and transverse sinuses were performed. With the endoscopic holder, endoscopic procedures were performed using standard 2-hand microsurgical techniques. Whether the tentorium or Meckel cave was handled depended on the tumor extension.The mean diameter was 45 × 25 mm. Dizziness and headache were the main symptoms. All 10 patients achieved gross total or subtotal resection (Petroclival Meningioma Grade I-III) with good neurological outcomes. The EF-SCITA provides satisfactory, direct exposure to the petroclival region. Cranial nerve deficits are the main postoperative complications. Two patients had a trochlear nerve injury, 3 patients had transient facial paralysis, and 2 patients had oculomotor paralysis (1 total and 1 incomplete), but both of them recovered during the follow-up period. One patient experienced an ipsilateral superior cerebellar artery infarction, and another patient had transient hemiparesis.The EF-SCITA is effective for most petroclival region meningiomas, except for the cavernous sinus type. This approach simplifies craniotomy procedures, omits burdensome petrosectomy, and avoids crossing posterior neurovascular structures.

Background Pituitary neuroendocrine tumors (PitNETs) are common intracranial tumors that are classified into seven histological subtypes, including lactotroph, somatotroph, corticotroph, thyrotroph, gonadotroph, null cell, and plurihormonal PitNETs. However, the molecular characteristics of these types of PitNETs are not completely clear. Methods A total of 180 consecutive cases of PitNETs were collected to perform RNA sequencing. All subtypes of PitNETs were distinguished by unsupervised clustering analysis. We investigated the regulation of TPIT by TRIM65 and its effects on ACTH production and secretion in ACTH-secreting pituitary cell lines, as well as in murine models using biochemical analyses, confocal microscopy, and luciferase reporter assays. Results A novel subtype of PitNETs derived from TPIT lineage cells was identified as with normal TPIT transcription but with lowered protein expression. Furthermore, for the first time, TRIM65 was identified as the E3 ubiquitin ligase of TPIT. Depending on the RING domain, TRIM65 ubiquitinated and degraded the TPIT protein at multiple Lys sites. In addition, TRIM65-mediated ubiquitination of TPIT inhibited POMC transcription and ACTH production to determine the fate of the novel subtype of PitNETs in vitro and in vivo. Conclusion Our studies provided a novel classification of PitNETs and revealed that the TRIM65-TPIT complex controlled the fate of the novel subtype of PitNETs, which provides a potential therapy target for Cushing’s disease.

Background and objective: The highly widespread and infiltrative nature of glioblastoma multiforme (GBM) makes complete surgical resection hard, causing high recurrence rate and poor patients’ prognosis. However, the mechanism underlying GBM migration and invasion is still unclear. In this study, we investigated the role of a Ras-related protein Rab32 on GBM and uncovered its underlying molecular and subcellular mechanisms that contributed to GBM aggressiveness. Method: The correlation of Rab32 expression with patient prognosis and tumor grade was investigated by public dataset analysis and clinical specimen validation. The effect of Rab32 on migration and invasion of GBM had been evaluated using wound healing assay, cell invasion assay, as well as protein analysis upon Rab32 manipulations. Mitochondrial dynamics of cells upon Rab32 alterations were detected by immunofluorescence staining and western blotting. Both the subcutaneous and intracranial xenograft tumor model were utilized to evaluate the effect of Rab32 on GBM in vivo. Results: The expression level of Rab32 is significantly elevated in the GBM, especially in the most malignant mesenchymal subtype, and is positively correlated with tumor pathological grade and poor prognosis. Knockdown of Rab32 attenuated the capability of GBM’s migration and invasion. It also suppressed the expression levels of invasion-related proteins (MMP2 and MMP9) as well as mesenchymal transition markers (N-cadherin, vimentin). Interestingly, Rab32 transported Drp1 to mitochondrial from the cytoplasm and modulated mitochondrial fission in an ERK1/2 signaling-dependent manner. Furthermore, silencing of Rab32 in vivo suppressed tumor malignancy via ERK/Drp1 axis. Conclusion: Rab32 regulates ERK1/2/Drp1-dependent mitochondrial fission and causes mesenchymal transition, promoting migration and invasion of GBM. It serves as a novel therapeutic target for GBM, especially for the most malignant mesenchymal subtype.

Background Trigeminal schwannomas (TSs) are mostly benign tumors and the dumbbell-shaped subtype is the most challenging, surgery remains difficult and risky. Objective We introduce a novel surgical approach named endoscopic far-lateral infratentorial supracerebellar approach (EFL-SCITA) for removing dumbbell-shaped TSs, and further discuss our experience and operation technique. Methods EF-SCITA was performed for resection of 5 cases of TSs between January 2020 and April 2022. The entire procedure was done endoscopically with the goal of total tumor resection. During the operation, the tumor was exposed in close proximity and multiple angles under the endoscope, and the peri-tumor nerves were carefully identified and protected, especially the normal trigeminal fiber bundles around the tumor. Results All the tumors of 5 cases involved the middle and posterior cranial fossa, of which total removal was achieved in 2 cases, near-total removal in 2 cases and subtotal removal in 1 case. Most common preoperative symptoms improved after surgery. Two patients had postoperative mild facial paralysis (House-Brackmann grade II), 1 patient had abducens palsy, both recovered during the follow-up period. Two patients experienced new postoperative facial hypesthesia and 1 experienced mastication weakness, which were not recovered. There was no tumor recurrence or residual tumor growth during the follow-up period in any of the patients. Conclusion EFL-SCITA is a new and effective alternative for the surgical treatment of TSs. For dumbbell-shaped TSs, this approach provides sufficient surgical field exposure and freedom of operation.

Aiming at the distance measurement of moving sound sources in shallow seas, this paper proposes a method of histogram filtering to realize underwater distance estimation of moving sound sources in shallow seas. The algorithm used the transmission loss, target motion parameter in the sound propagation and receival signal as prior knowledge to updated the state vector of the sound source, so as to realize the distance estimation of the shallow sea sound source, and this paper used SwellEx-96 database for experimental verification. The experimental results shown that: the depth estimating error of moving sound source is small, and when the detected horizontal distance is in the range of 10 km, the maximum range error of the horizontal distance is ±10 m, meanwhile the accuracy of ranging can be improved by improving the prior knowledge of the target motion parameters, which verifies that the histogram filtering algorithm can achieve better ranging for underwater moving targets.

The deep location of the thalamus and the complex neural circuits in the surrounding area make surgery extremely challenging. Feasibility and advisability of using a supracerebellar infratentorial approach (SCITA) for endoscopic resection of thalamic lesions remains to be further evaluated. Fifteen patients who underwent endoscopic resection of thalamic via SCITA from 2014 to 2021 were retrospectively collected. We analyzed preoperative tumor-related variables and surgical procedures in detail, as well as postoperative outcomes. Lesions mainly located in the posterior and/or medial part of the thalamus, and some of them expanded downward, or backward. The mean size of them was 30 × 24 mm. Five of the nine patients with preoperative hydrocephalus underwent cerebrospinal fluid shunts to relieve increased intracranial pressure. Among the 15 patients, 4 were glioblastoma, 3 were pilocytic astrocytoma, and the rest included 1 case of anaplastic astrocytoma, melanoma, polymorphous low-grade neuroepithelial tumor of the young, rosette-forming glioneuronal tumor, inflammatory lesion, diffuse midline glioma, and cavernous hemangioma. The majority of patients (10/15) achieved gross total resection, which has become more pronounced since paramedian SCITA was used in place of the midline approach in 2020 (6/8). Three patients had unresolved or new onset of clinical symptoms after surgery, resulting in a decreased KPS score at discharge. Neuro-endoscopic techniques can ameliorate many of the shortcomings of the SCITA. With the accumulation of experience and technological progress, more deficiencies of this approach may be improved, enabling safe and effective resection of posterior and/or medial part thalamic lesions.

Somatotroph adenomas are obviously heterogeneous in clinical characteristics, imaging performance, pathological diagnosis and therapeutic effect. The heterogeneity of the tumors, especially for SG and DG type adenomas, have attracted great interest in identifying the specific pathological markers and therapeutic targets of them. However, previous analyses of the molecular characteristics of the subtypes of somatotroph adenomas were performed at genomic and transcriptome level. The proteomic differences between the two subtypes of somatotroph adenomas are still unknown. Tumor samples were surgically removed from 10 sporadic pituitary somatotroph adenoma patients and grouped according to the pathological type. Tandem mass tag (TMT)-based quantitative proteomic analysis was employed to analyze the proteomic differences between SG and DG tumors. In total, 228 differentially expressed proteins were identified between SG adenomas and DG adenomas. They were enriched mainly in extracellular matrix (ECM)-receptor interaction, leukocyte transendothelial migration, arrhythmogenic right ventricular cardiomyopathy and DNA replication pathways. Protein-protein interaction (PPI) network analysis indicated that Cadherin-1 and Catenin beta-1 were the most important key proteins in the differences between SG and DG adenomas. Immunohistochemistry (IHC) confirmed the expression levels of the key proteins. This study provides large-scale proteome molecular characteristics of distinct granulation subtypes of somatotroph adenomas. Compared with DG adenomas, The differential protein of SG adenomas mostly enrich in invasive and proliferative functions and pathways at the proteomic level. Cadherin-1 and Catenin beta-1 play key roles in the different biological characteristics of the two tumor subtypes.

Background Studies have shown that microvascular decompression (MVD) surgery could improve the clinical symptoms of hemifacial spasm (HFS) and decrease the blood pressure (BP) in patients with refractory hypertension. More positive long-term results are required to establish MVD as a treatment option for high blood pressure (HBP) and to refine the patient selection criteria. Methods From October 2015 to September 2018, based on patient selection for cases with both HFS and poorly controlled HBP of nervous origin, MVD surgeries were performed on 12 patients aiming for better BP control. The patients were followed-up for at least 2 years. The surgical outcomes and associated factors were analyzed. Results With respect to neurovascular compression (NVC) of facial nerve, the intra-operative findings concurred with pre-operative radiological findings except that in one case. Intra-operatively ipsilateral cranial nerve (CN) IX–X root exit zone (REZ) and rostral ventrolateral medulla (RVLM) NVCs were confirmed and concordant with pre-operative radiological findings in all 12 cases. 9 Of the 12 cases were completely free of facial spasm after surgery. 2 patients achieved partial relief. 1 patient still suffered from frequent facial spasm. 10 out of 12 patients achieved BP lowering after surgery. The BP of those 10 patients stayed at a relatively stable scale over the follow-up period. Although statistical significance was not obtained, for patients who are operated on the left side and those who have only 1 offensive artery, the surgery might lead to better BP control. Conclusions MVD is a safe and effective treatment for hypertension due to central nervous system (CNS) NVC in patients with both HBP and HFS. Further studies are required to examine long-term outcomes and establish criteria for patient selection.

BACKGROUND Craniopharyngiomas that rarely extend into the posterior fossa are treated with staged operations or combined approaches. The authors reported a patient undergoing gross-total resection of a suprasellar with recurrent cerebellopontine angle (CPA) craniopharyngioma using an endoscopic far-lateral supracerebellar infratentorial approach (EFL-SCITA). OBSERVATIONS The patient was a 15-year-old boy who presented with headache and decreased vision that lasted for half a year. He previously received three surgeries related to CPA craniopharyngioma. Preoperative magnetic resonance imaging revealed a suprasellar with recurrent CPA craniopharyngioma. Gross-total resection of this suprasellar and CPA tumor was achieved through EFL-SCITA. All symptoms and signs were improved. There were no postsurgical complications except for mild facial paralysis. LESSONS EFL-SCITA can be used not only for tumors in the posterolateral pontomesencephalon and ptero-clival-tentorial area but also for tumors in the suprasellar region with posterior fossa extension.

In microvascular decompression (MVD) surgery, abnormal muscle response (AMR) monitoring was utilized to confirm sufficient decompression. However, the AMR seems to contain more information that could improve surgical results.Patients' records of HFS treated with MVD under AMR monitoring, from January 2018 to December 2019 in our centre, were retrospectively reviewed. MVD procedures were performed via a suboccipital retrosigmoid approach, and AMR monitoring was performed. Pre-Decompression Instability (PDI) of AMR before the final decompression, including amplitude inconsistency and waveform chaos, was inspected and notified to the surgeon.165 cases were found with full follow-up data. In these cases, PDI was recognized in 144 cases. And in the remaining 21 cases, the AMR disappeared abruptly or continued to exist to the end of the MVD surgery. When PDI appeared, the rate of electrophysiological relief was significantly higher (91.7 % vs 66.7 %, P = 0.001). In cases with PDI appearance during MVD procedure, the rate of neurological dysfunction was lower (13.2 % vs 38.1 %, P = 0.004). The relief rate the PDI group tended to be higher without statistical significance.The appearance and observation of pre-decompression instability of AMR monitoring made a positive impact on the surgical outcomes of MVD surgeries. The advent of PDI indicates that the key step of the procedure has arrived. The timely notification of the PDI advent improved the surgical outcomes of MVD surgery by increasing the electrophysiological relief rate, reducing the incidence of neurological dysfunction, and possible elevation of the relief rate. Therefore, continuous intra-operative communication between the surgeon and electrophysiological monitoring staff should be encouraged.

There is an increasing agreement that acromegaly caused by growth hormone (GH) cell adenoma has two distinct subtypes: densely granulated (DG) and sparsely granulated (SG). We hypothesized that differential molecular signatures may explain their behavior. Total transcriptome sequencing was performed on ten DG and seven SG adenomas. The differentially expressed RNAs were identified by bioinformatic analyses, and a candidate RNA was verified by quantitative real-time PCR. Immunohistochemical staining was also performed to detect the protein expression of the candidate. Clinical parameters were correlated with protein expression. Subsequently, cell proliferation, colony formation, and cell cycle progression were analyzed after knockdown of the candidate in pituitary GH3 cells. Activation of the cAMP pathway was assessed by ELISA and Western blot. We confirmed that there were obvious differentially expressed genes between the subtypes. Through gene profiling, we discovered that an orphan adhesion G protein-coupled receptor, GPR64, was overexpressed in more aggressive SG adenomas. Noticeably, GPR64 knockdown significantly inhibited the proliferation of GH3 tumor cells and decreased colony formation. The knockdown also induced cell cycle arrest in GH3 tumor cells. Further studies revealed that GPR64 knockdown decreased cAMP levels and the ratios of p-CREB/CREB, indicating that it suppressed the cAMP/CREB pathway. Our results indicated that GPR64 may promote aggressiveness in SG-type GH cell adenomas and that it is a key factor regulating the cAMP pathway to promote aggressiveness of GH cell adenomas.

An increased serum phosphate (P) level is common in acromegaly patients, however, the relationships among P, growth hormone (GH), insulin-like growth factor 1 (IGF-1) and disease status remain unknown. To reveal these relationships, we examined the association of P with comprehensive clinical data. We measured the serum P, calcium, GH, oral glucose tolerance test-GH (OGTT-GH), IGF-1, and insulin-like growth factor binding protein-3 (IGBP-3) levels in 103 acromegaly patients. SAGIT® was used to assess the disease status comprehensively. Spearman’s rank correlation coefficient was obtained to evaluate the associations among the above parameters. Stepwise multiple linear regression analysis was performed to investigate factors independently associated factors with the SAGIT scores. The area under the receiver operating characteristic curve (AUCROC) was used to evaluate the efficacy of the percentage change in the serum phosphate level in predicting remission in patients with postoperatively discordant GH and IGF-1 levels. Hyperphosphatemia was found in 68.9% of patients at baseline. The serum P level was higher in the non-remission group, but no correlation was found between hyperphosphatemia and remission. We revealed a significant correlation between the P level and SAGIT® score in patients both preoperatively (r = 0.659, p = 0.000) and 1-year postoperatively without remission patients (r = 0.534, p = 0.027). All biochemical levels decreased significantly postoperatively, and the GH and OGTT-GH levels achieved early stability (1 month); however, the P, IGF-1 and IGBP-3 levels showed a gradual decline. A percentage change in P of −8.12% is recommended as a cut-off value for predicting remission in patients with postoperatively discordant GH and IGF-1 levels. As a metabolic product which affected by the GH/IGF-1 axis, serum P appears to more closely reflect the comprehensive disease status in acromegaly. When the GH and IGF-1 levels are discordant during follow-up, perioperative change in the P level may be a potential predictor of remission.

BackgroundSurgery for thalamic lesions is generally challenging because they are deep-seated and surrounded by vital neurovascular structures. Whether neuronavigation via middle frontal gyrus endoport-assisted endoscopic resection for thalamic lesions is safe and effective remains to be further evaluated.Materials and MethodsTwelve patients treated surgically were retrospectively reviewed using the neuronavigation endoport-assisted endoscopy between January 2016 and April 2021 at Zhongshan Hospital of Fudan University. Preoperative and tumor-related variables, as well as postoperative outcomes, were also collected.ResultsAll lesions located in the medial part of the thalamus, and some of them expanded forward, downward, or backward. The median size of lesions was 29 mm (range 16-56 mm). The final pathology results showed 4 cases of benign lesions, 4 cases of low-grade glioma, and 4 cases of glioblastoma. All of the cases with benign lesions and low-grade glioma (100%) achieved GTR, while 3/4 (75%) of cases with glioblastoma achieved NTR, and 1 (25%) case obtained STR. None of the patients in this study have postoperative seizures. In the benign lesions and low-grade glioma group, worse Karnofsky performance status scores at discharge were 25%, and all achieved long-term postoperative survival. For patients with glioblastoma, 3/4 cases had worse Karnofsky performance status scores at discharge, and died within 6 months. ConclusionCombining the advantages of neuronavigation, endoscopy, and endoport techniques via the middle frontal gyrus approach can safely and effectively remove benign lesions and low-grade glioma in the medial part of the thalamus.

Dural arteriovenous fistulas (DAVFs) in the falx cerebri are rare. This study presents a case of DAVF in the frontal falx cerebri that was successfully resected using a purely endoscopic keyhole microsurgical technique.A 69-year-old male patient presented to the emergency department with an acute onset seizure. His condition was diagnosed as a DAVF in the frontal falx cerebri with multiple fistula points. A purely endoscopic resection was performed under neuronavigation. Postoperative angiography and clinical follow-up were performed after 10 days and 3 months, respectively.The DAVF was satisfactorily observed and resected using a purely endoscopic keyhole microsurgical technique, with no deterioration of neural functions or major vessel ruptures. Postoperative angiogram revealed complete obliteration of the DAVF and no recurrent epilepsy during the clinical follow-up.Supported by sufficient preoperative evaluation and meticulous manipulation,a purely endoscopic minimally invasive resection is feasible and safe for DAVF, with the advantages of close observation and panoramic view.

Background Benign fibrous histiocytoma (BFH) is a benign tumor composed of cells with characteristics of histiocytes and with fibroblastic components. BFHs are rare lesions, especially in the skull base. Clinical presentation Here, the authors report the case of a 9-year-old girl presented with reduced binocular vision for 2 months. The computerized tomography (CT) of the tumor appearance was high-density annular sclerosis. The tumor was removed via nasal endoscopic approach. Final pathologic diagnosis was benign fibrous histiocytoma. The post-operative period was uneventful after 8 months, and the visual acuity was improved to some extent. Discussion and conclusion This is the first case of BFH in a pediatric patient that was removed by endoscope. For similar case, endoscopic resection might be the first choice, including pediatric patient. Moreover, the CT feature and literature review may provide further insight into the diagnosis and management.

We developed a method to better estimate the carbon stocks of in-use harvested wood products (HWP) by using the Eora multiregional input-output tables to link global HWP production and end uses, compared to existing global-scale studies that focused on semifinished HWP. Using the new method, we allocated global HWP to country-specific end uses, including solid HWP used in (1) construction, (2) furniture production, and (3) other end uses, and as (4) household and sanitary paper and (5) other paper and paper products, while the HWP carbon stocks in these end uses were estimated using the Stock Change Approach. We reported that HWP produced globally contained an annual average of 277.7 teragram carbon in 1992-2015, of which 63.0, 12.6, 76.7, 9.1, and 116.3 teragram carbon were consumed by the above five end uses, respectively. By 2015, the carbon stocks of global in-use HWP produced since 1992 accumulated to 2938 teragrams of carbon, of which the above five HWP end uses accounted for 1489, 268, 890, 0, and 291 teragrams of carbon, respectively. Country-specific HWP production and consumption varied significantly, with the eight leading consuming countries (United States, China, Japan, Canada, Germany, Russia, United Kingdom, and France) accounting for 69% of the global in-use HWP carbon stocks. published

Harvested wood products (HWP) are essential carbon pool of the forestry sector and can play an important role in climate change mitigation. Since the 10th Conference of Parties to the United Nations Framework Conversion on Climate Change in 2009, HWP have been required to be included in forest management as an additional carbon pool in national greenhouse gas (GHG) inventory reports. China is the largest consumer of end-use HWP and the largest importer of primary HWP in the world. Thus, the carbon stocks and emissions of China's HWP must be accurately assessed for evaluating their contribution to the climate change mitigation potential of global HWP. We developed an analysis framework by using Stock-Change Approach to estimate China's HWP carbon stocks/emissions from a life-cycle perspective, which covers three HWP life-cycle stages, namely, manufacture, end use, and end-of-life disposal. Using this framework, we produced the first-ever life-cycle carbon budget for HWP consumed by China in the period 1900–2015, based on a comprehensive analysis of China-specific data. From 1900 to 2015, total wood fiber input to the HWP carbon system in China was estimated to be 8049 teragrams of carbon dioxide-equivalent (Tg CO2-eq). Of the total wood fiber input, discarded mill residue, in-use HWP, and HWP disposed of at solid waste disposal sites retained 513, 3284, and 659 Tg CO2-eq of carbon, respectively, with the remaining 3591 Tg CO2-eq of wood carbon released back to the atmosphere. Of the total emission, combustion and decomposition of mill residue, burning of fuelwood, and combustion and decomposition of retired HWP accounted for 36.5%, 24.6%, and 38.9%, respectively. Landfill methane emissions were estimated to be 780 Tg CO2-eq after considering the global warming potential of this greenhouse gas. The net HWP carbon stocks, the sum of the carbon retained by discarded mill residue and the carbon stocks of HWP in use and in landfills, minus landfill methane emissions, increased from 297 Tg CO2-eq in 1950 to 4456 Tg CO2-eq in 2015.

Objective We sought to report the operative techniques of the endoscopic supracerebellar transtentorial approach (ESTA) to the atrium of the lateral ventricle, especially focusing on the role of the endoscope and analyzing optically related issues. Methods A retrospective data review was performed on 5 patients with lesions in the atrium of the lateral ventricle undergoing the ESTA. The patients were positioned in the three quarters prone position, and a paramidline linear incision was used. After performing a suboccipital craniotomy extending immediately above the transverse sinus and tentorium incision with precisely neuronavigation, corticotomy in the posterior mediobasal temporal region created a corridor to the tumor. All of the procedures were performed with an endoscope in a pneumatic arm holder. The preoperative and postoperative perimetry test and diffusion tensor imaging fiber tracking of the optic radiations were compared and analyzed. Results Three patients had meningiomas, and 2 patients had high-grade gliomas in the atrium. The meningiomas were totally removed, and the gliomas were subtotally resected. One patient with glioblastoma died 2 months later after surgery because of the tumor progression; the remaining 4 patients had a visual field deficit without any other neurologic complications. The endoscope improved the surgical viewing angle, which was restricted by the microscope and slope of the tentorium. Conclusions ESTA is an alternative route to the atrium of the lateral ventricle. However, the collateral sulcus, which is highly relied on in neuronavigation, is illegible in the limited area. And the visual field deficit remains the primary challenge with this approach.

The microRNAs (miRNAs) are involved in multiple pathological processes among various types of tumors. However, the functions of miRNAs in benign brain tumors are largely unexplored. In order to explore the pathogenesis of the invasiveness in non-functional pituitary adenoma (NFPA), the miRNAs expression profile was analyzed between invasive and non-invasive non-functional pituitary adenoma by miRNAs microarray. Six most significant differentially expressed miRNAs were identified including four upregulated miRNAs hsa-miR-181b-5p, hsa-miR-181d, hsa-miR-191-3p, and hsa-miR-598 and two downregulated miRNAs hsa-miR-3676-5p and hsa-miR-383. The functions and corresponding signaling pathways of differentially expressed miRNAs were investigated by bioinformatics techniques, including Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis. The result of GO analysis indicates regulation of voltage-gated potassium channel activity, positive regulation of sodium ion transport, positive regulation of GTPase activity, negative regulation of Notch signaling pathway, etc. KEGG pathway reveals a series of biological processes, including prolactin signaling pathway, endocrine and other factor-regulated calcium reabsorption, fatty acid metabolism, neuroactive ligand-receptor interaction, etc. The miRNAs hsa-miR-181a-5p was verified by quantitative real-time PCR, and the expression level was in accordance with the microarray result. Our result can provide the evidence on featured miRNAs which play a prominent role in pituitary adenoma as effective biomarkers and therapeutic targets in the future.

The extraction of human physiological based on face video has become a hot research direction, but few researchers pay attention to the process of signal extraction from an optical perspective. This paper establishes an optical model for human skin, and analyzes the principle of extracting human physiological signals from face video by imaging. Based on this model, the effects of melanin and hemoglobin on BVP (blood volume pulse) signal extraction were analyzed. In addition, this paper introduces the model of camera imaging, and discusses the cause of noise generation, analysis of the impact of two kinds of noise on video quality. Finally, this paper uses the MAHNOB database to carry out the heart rate extraction experiment from video, the experiment concluded that: (1) The face with lighter skin color is more conducive to human heart rate extraction; (2) Reducing the signal-noise ratio through compressing the video quality, the impact on the heart rate estimation error reaches minimum as the signal-noise ratio is 30dB; (3) By compressing the original video resolution, color information in the video is reduced, which has a impact on BVP signals extraction, the information recovery can be performed by the method of super-resolution reconstruction.

Background The cerebellomesencephalic vein (CMV) was frequently sacrificed in surgery approached via the supracerebellar infratentorial (SCIT) route for resecting pineal region tumors, which resulted in potential risk of neurologic deficit. Preserving the CMV in the SCIT approach could enhance the safety and effectiveness of this natural corridor surgery. The aim of this article was to identify the probability and safety of preserving the CMV through the application of neuroendoscopy in the SCIT approach. Methods Clinical data of patients who underwent pineal region tumor resection through a purely endoscopic SCIT approach were retrospectively analyzed, focusing on surgical techniques and clinical outcomes. Results The study included 8 patients with pineal region tumors. The CMV was preserved intact in all patients. Total tumor removal was achieved in 7 of 8 patients. In 1 patient with 2 tumors in the pineal region and roof of the third ventricle, the tumor in the pineal region was resected completely, followed by subsequent chemotherapy combined with radiotherapy, after which the other tumor disappeared totally. All patients recovered normally with uneventful postoperative outcomes. Conclusions The advantage of close observation and panoramic view provided by neuroendoscopy combined with meticulous manipulation improved the ability to preserve the CMV in resecting pineal region tumors via the SCIT approach. The neuroendoscopic technique enhances the safety and efficacy of the SCIT approach.

Infratentorial supracerebellar approach via microscope still has some limitations in resection of pineal region tumors. The authors describe a purely endoscopic infratentorial supracerebellar approach for resection of pineal region tumors with matched air-driven arm and navigation. The lateral oblique position is adopted. The same bimanual microsurgical techniques are utilized in this endoscopic approach with panoramic view and satisfying comfort. Purely endoscopic resection of pineal region tumors using infratentorial supracerebellar approach is feasible. It may be considered as an alternative approach for certain pineal region tumors.

Global and gene-specific changes to the epigenome are hallmarks of most tumours including those of pituitary origin, and this fact might offer important clues about diagnostic and therapeutic applications. We performed global DNA methylation screening with 6 invasive and 6 noninvasive nonfunctioning pituitary adenomas (PA) to investigate whether DNA methylation was associated with the invasion of nonfunctioning pituitary adenomas. An additional seven PAs were included as an independent cohort to validate the initial results. Five thousand nine hundred thirty-one CpGs were selected (△β ≥0.15 and p value ≤0.01) as differentially methylated sites (DMSs). The hypomethylated DMSs in the invasive PAs were significantly more than the hypermethylated sites. Cluster analysis of 339 CpGs (△β ≥0.25 and p value ≤0.001) demonstrated a complete distinction between the invasive and noninvasive nonfunctioning groups. GO analysis of the three hundred seven corresponding genes shown they were involved in homophilic cell adhesion, cell-cell adhesion, cell adhesion and biological adhesion. The mRNA expression of GALNT9 which contain a validated DMS was significantly downregulated in invasive group. Our findings indicate that the differential DNA methylome profiling of invasive and noninvasive nonfunctioning PAs suggesting tumour invasion is correlated with cell adhesion.

Objective To investigate the role of endoscopic endonasal transsphenoidal surgery and the pseudocapsule in the treatment of growth hormone adenomas. Methods The study included 43 patients (age range, 21–64 years) with growth hormone adenomas treated with an endoscopic endonasal approach. We compared the tumor characteristics and surgical outcomes of cases with (group A, 21 cases, from November 2013 to January 2015) and without (group B, 22 cases, from October 2011 to October 2013) extra-pseudocapsule resection. Results The preoperative demographics, tumor characteristics, and surgical complications were not significantly different between groups A and B. Postoperative remission without adjuvant therapy was achieved in 18 of 21 cases (85.7%) in group A, which was significantly greater than that observed in group B (12 of 22 cases [54.4%]). In group A, the pseudocapsules were verified by endoscopy and histopathology. The pseudocapsule was removed en bloc with the whole adenoma in only 5 cases (23.8%). For the remaining 16 patients (76.2%), following extra-pseudocapsule dissection, incomplete pseudocapsule removals with intracapsule procedures were achieved. Conclusions The combination of extra-pseudocapsule resection and endoscopy led to a high rate of gross total tumor resection and endocrinologicl remission in acromegalic patients compared with the group with intracapsular resection. Extra-pseudocapsule resection resulted in no additional postoperative complications.

// Yang Xing 1, * , Yuqing Ge 1, * , Chanjuan Liu 1, * , Xiaobiao Zhang 2 , Jianhai Jiang 1 , Yuanyan Wei 1 1 Key Laboratory of Glycoconjuates Research, Ministry of Public Health, Department of Biochemistry and Molecular Biology, Shanghai Medical College of Fudan University, Shanghai, People’s Republic of China 2 Division of Neurosurgery, Zhongshan Hospital, Fudan University, Shanghai, People’s Republic of China * These authors have contributed equally to this work Correspondence to: Yuanyan Wei, e-mail: yywei@fudan.edu.cn Jianhai Jiang, e-mail: jianhaijiang@fudan.edu.cn Xiaobiao Zhang, e-mail: xiaobiao_zhang@163.com Keywords: glioma-initiating cell, tunicamycin, Sox2, self-renewal Received: December 02, 2015 Accepted: April 11, 2016 Published: April 23, 2016 ABSTRACT Glioma-initiating cells possess tumor-initiating potential and are relatively resistant to conventional chemotherapy and irradiation. Therefore, their elimination is an essential factor for the development of efficient therapy. Here, we report that endoplasmic reticulum (ER) stress inducer tunicamycin inhibits glioma-initiating cell self-renewal as determined by neurosphere formation assay. Moreover, tunicamycin decreases the efficiency of glioma-initiating cell to initiate tumor formation. Although tunicamycin induces glioma-initiating cell apoptosis, apoptosis inhibitor z-VAD-fmk only partly abrogates the reduction in glioma-initiating cell self-renewal induced by tunicamycin. Indeed, tunicamycin reduces the expression of self-renewal regulator Sox2 at translation level. Overexpression of Sox2 obviously abrogates the reduction in glioma-initiating cell self-renewal induced by tunicamycin. Taken together, tunicamycin suppresses the self-renewal and tumorigenic potential of glioma-initiating cell partly through reducing Sox2 translation. This finding provides a cue to potential effective treatment of glioblastoma through controlling stem cells.

Transoral microscopic odontoidectomy followed by posterior fixation has been accepted as a standard procedure to treat nonreducible basilar invagination during the half past century. In recent years, the development of endoscopic techniques has raised challenges regarding the traditional treatment algorithm. The endoscopic transnasal odontoidectomy is a feasible and effective method in the treatment of irreducible ventral cervicomedullary junction compression, which has several advantages over the transoral approach. The endoscopic odontoidectomy includes transnasal, transoral, and transcervical approaches. The 3 different approaches for endoscopic odontoidectomy present complementary advantages and limitations. The necessity of posterior fixation after odontoidectomy should be considered in every single case on the basis of the peculiar anatomic and clinical conditions.

Acromegaly is a systemic metabolic disease. Growth hormone (GH) have a significant impact on adipose tissue (AT). A huge reduction of serum GH after surgical treatment may cause substantial AT redistribution. The objective of this study was to illustrate the dynamic changes in distribution of facial and abdominal AT correlated with surgical treatment in patients with acromegaly. Abdominal AT in 17 acromegaly patients (group 1) was studied longitudinally preoperatively and 1 month to 1 year postoperatively. The facial and abdominal subcutaneous AT (fSAT and aSAT) of another 17 acromegaly patients (group 2) were compared with 7 nonfunctional pituitary adenoma (NFPA) controls. The areas of fSAT, aSAT, and visceral adipose tissue (VAT) were obtained by MRI and quantified by image analysis software, and intrahepatic lipid (IHL) was assessed by 1H magnetic resonance spectroscopy (MRS). Abdominal adipose tissue (aSAT, VAT, and IHL) increased overall after surgical treatment. However, IHL first decreased and then continuously increased during the follow-up. Compared with the increased amount of aSAT, the fSAT amount decreased after surgical treatment. The inconsistency of this phenomenon did not appear in the NFPA control subjects. The perioperative dynamic distribution of the facial and abdominal fat in acromegaly revealed regional differences in the intricate effect of GH on adipose tissue. Reduction of serum GH after surgical treatment of acromegaly was associated with dynamic increases of IHL, abdominal visceral, and subcutaneous fat, but a reduction of facial subcutaneous fat.

OBJECT The translamina terminalis corridor was used in the transcranial anterior route to treat third ventricular craniopharyngioma (TVC), which presents a challenge to neurosurgeons. The endoscopic endonasal approach (EEA) has recently been used to treat craniopharyngiomas. However, there are few reports of the EEA being used to treat TVC. The authors' novel surgical approach of treating selected TVC by the endoscopic endonasal route via the suprachiasmatic translamina terminalis (STLT) corridor is described. METHODS In this single-center study, the EEA via the STLT corridor was used to resect TVC with great upper and anterior extension causing bulged lamina terminalis, and TVC with a residual upper compartment, after routine infrachiasmatic transmetastalk corridor resection. RESULTS The STLT corridor was used in 3 patients. Gross-total resection was achieved in all cases. One patient achieved visual improvement, and the other 2 patients showed partial visual improvement. Leakage of CSF occurred in 1 patient. Postoperative hormone replacement therapy was required in all patients. CONCLUSIONS The STLT corridor is a complementary minimally invasive corridor used in the EEA for treating selected TVC. The STLT alone or combined with infrachiasmatic transmetastalk corridors should be selected depending on the size of suprachiasmatic and infrachiasmatic space.

To assess the efficacy of the combined use of a gasket seal closure and a vascularized pedicle nasoseptal flap (VP-NSF) multilayered reconstruction technique for high-flow cerebrospinal fluid (CSF) leaks resulting from endonasal endoscopic skull base surgery.From October 2009-June 2011, a VP-NSF multilayered reconstruction technique was used (single technique group) for patients with intraoperative high-flow CSF leaks; from July 2011-February 2013, a combination of a gasket seal closure and a VP-NSF multilayered reconstruction technique was used (combined technique group). A lumbar drain was placed after the operation. The rates of postoperative CSF leaks and repair-related complications in the 2 groups were analyzed.The single technique group comprised 18 patients with a mean follow-up of 31.7 months; there were 5 postoperative CSF leaks (27.7%). The combined technique group comprised 15 patients with a mean follow-up of 13.6 months; no CSF leaks occurred (P0.05). The rate of intracranial infection in the single technique group was significantly higher than in the combined technique group.The combined use of a gasket seal closure and a VP-NSF multilayered reconstruction technique for high-flow CSF leaks after endonasal endoscopic skull base surgery may significantly reduce the rates of postoperative CSF leaks and intracranial infections. Lumbar drainage after the operation is a necessary auxiliary method.

With the increasing number of lung cancer patients, the CAD system is playing an increasingly important rule in the field of automatic identification for medical images. Since the 3D characteristics of low-dose CT images make the 3D convolution more suitable than 2D convolution, in this paper, we propose a method to detect lung nodule of lung CT images using 3D convolutional neural networks. Combined with the traditional morphological preprocessing methods, 3D convolutional neural networks are applied to lung CT images. The experimental accuracy indicates that this method is suitable for the problem of lung nodule detection and has great room to improve. The experimental results also demonstrate that the application of deep learning in the medical field will bring great progress for medical development.

Surgery in the trigone of the lateral ventricle remains a challenge for neurosurgeons. In recurrent trigonal meningiomas (RTM), the disturbance of normal anatomic structures and adhesion due to previous surgeries, significant oedema, and their malignant properties heighten the difficulties associated with their surgical removal. This report presents two patients with recurrent meningiomas with anaplastic transformation at the trigone of the lateral ventricle who were successfully treated with contralateral posterior interhemispheric transfalcine transprecuneus (CITT) surgeries. The primary tumours were both completely removed through a transparietal approach in previous surgeries, but both patients experienced hemianopsia postoperatively. The second surgeries resulted in the complete resection of the recurrent tumours without any new-onset neurological dysfunction. The CITT approach suits most trigonal lesions with advantages of optic radiation preservation, reduction of retraction, improved exposure, and navigation accuracy, and because it addresses the origin of the trigonal lesion. Although the characteristics of RTM heighten the difficulty associated with their surgical removal, these challenges highlight the advantages of the CITT approach. In conclusion, the CITT approach is a safe and effective procedure for the removal of RTM.